Subject Matter Expert — Healthcare

Subject Matter Expert — Healthcare, NetworkIQ Company: HiLabs Location: Bethesda, MD (hybrid) Reports To: SVP & Chief Innovation Officer Department: Product — Provider Network Solutions About HiLabs HiLabs is a healthcare AI company building solutions that help health plans manage provider data, network adequacy, contracting, and clinical risk with greater speed and accuracy. NetworkIQ is HiLabs' network adequacy monitoring and compliance platform, helping payers demonstrate regulatory compliance, identify network gaps, and optimize provider networks using precise, geocoded provider and member data. About the Role We're looking for a Healthcare Subject Matter Expert to serve as the authoritative domain voice behind NetworkIQ — our network adequacy monitoring and reporting product. This is a hands‑on, high‑visibility role for someone who has lived on the payer side of network adequacy: building compliance filings, running adequacy analyses against state and federal standards, and defending network positions to regulators and internal stakeholders. You'll bring that operational depth to bear across the business — validating adequacy methodology, interpreting regulatory change, advising the product and engineering teams on what "correct" looks like, and representing HiLabs credibly in front of payer clients, regulators, and prospects. You will shape how the product thinks about geocoding precision, adequacy methodology, and regulatory nuance across states and lines of business (Commercial, Medicare Advantage, Medicaid). What You'll Do Act as the internal authority on network adequacy standards — CMS time/distance and minimum provider ratio requirements, state‑specific frameworks (e.g., commercial large‑group standards, Medicaid geographic classifications), and NCQA/URAC‑adjacent expectations. Monitor, review, and interpret regulatory materials (state DOI bulletins, CMS guidance, Medicaid managed care contracts) and issue clear, actionable domain guidance to product, engineering, and client teams. Validate NetworkIQ's adequacy logic and outputs against real‑world regulatory requirements — reviewing rule sets, methodology assumptions, edge cases, and determination accuracy before and after release. Advise the product team on domain requirements and priorities, reviewing specifications and acceptance criteria for regulatory and operational correctness rather than owning the backlog. Lead complex adequacy conversations with clients and account teams — including methodology defense (e.g., geocoding precision, ghost address detection, drive‑time/network routing logic) — and translate what you hear into recommendations for the roadmap. Define what audit‑ready, regulator‑facing reporting must contain, and review NetworkIQ outputs against filing and audit expectations. Build internal enablement — training, reference materials, and methodology documentation — so implementation, support, and sales teams can speak accurately about adequacy. Mentor and provide domain oversight to analysts, associate SMEs, or QA team members, with formal people‑management or matrixed team leadership experience. Partner with sales and competitive intelligence to ground NetworkIQ's differentiation in real methodology and regulatory rigor rather than marketing claims, including RFP responses and client escalations. Advise on domain KPIs (e.g., adequacy determination accuracy, filing readiness, gap‑closure rates) and interpret results in regulatory context. What You Bring 7+ years in health plan network operations, network adequacy, or provider network management, including direct, hands‑on responsibility for adequacy monitoring, filing, and/or reporting. Demonstrated experience reviewing and applying regulatory materials related to network adequacy (state DOI/Medicaid regulations, CMS network adequacy standards for MA/QHP) to real operational or compliance decisions. Prior people management or team leadership experience — you've hired, coached, and been accountable for a team's output, not just your own. Working knowledge of geocoding, drive‑time/distance modeling, and/or provider directory data quality. Ability to communicate credibly with both engineers and payer‑side operational stakeholders — you can speak "regulator" and "roadmap" in the same meeting. Comfort operating as an advisor and influencer without direct authority over delivery timelines. Bachelor's degree required; advanced degree a plus but not required in lieu of operational experience. Nice to Have Direct experience with a network adequacy software vendor (HiLabs, Quest Analytics, or similar) from either the vendor or client side. Familiarity with Medicare Advantage, Medicaid managed care, and Commercial network adequacy standards across multiple states. Experience with provider data platforms, roster automation, or network optimization tools. Experience presenting methodology to regulators, auditors, or client compliance committees. Why HiLabs You'll be the domain authority behind a product that sits at the center of how health plans prove and improve network access for millions of members — with direct exposure to executive stakeholders on both the client and HiLabs side, and a real seat in defining how the market thinks about adequacy methodology and transparency. #J-18808-Ljbffr F-Prime Capital